Posts Tagged ‘pandemic’

As the 2011 flu season gets underway, it is reported that the vaccines given for this dreaded disease may be far less effective than thought, according to a new study. Michael Osterholm, an infectious disease specialist at the University of Minnesota, found that the most common flu vaccine is effective for just 59 percent of healthy adults, well below the 70 percent to 90 percent level that is generally quoted. “We’re stuck with a vaccine that has been around for 60 years and not changed much,” Osterholm said. He stressed the need for an all-new generation of flu shots, especially in case there is a future pandemic.

Health officials recommend that all Americans over six months of age get a flu shot. Nearly 131 million people – just 43 percent of the population — received the flu vaccine in 2010, according to the Centers for Disease Control and Prevention (CDC).

Although Osterholm does not dispute the need for the current vaccines, he said the common perception that they are “good enough” obstructs the development of improved therapies. In a study published in The Lancet Infectious Diseases, Osterholm and his colleagues examined 5,707 vaccine studies published over the last 40 years. They focused 31 studies that tested for the presence of flu in laboratory tests rather than counting an increase in flu antibodies — a speedier method that researchers say overestimates the vaccine’s effectiveness. Additionally, they concentrated on results to those that used randomized controlled trials or other observational methods that did not have “selection bias,” which could lead to sicker people being excluded from the study.

The H1N1 vaccine performs slightly better than seasonal flu shots, preventing infection in 69% of adults under 65. Nasal sprays do even better, preventing infections in 83 percent of children aged seven or less, according to The Lancet. One study found that flu shots reduce hospitalizations by eight percent. That is significant, however, because the flu sends about 200,000 Americans to the hospital every year. The results should not deter people from getting vaccinated, Osterholm said. “We have an obligation to tell the public what we know. We know we need better vaccines. But 59 percent protection is still better than zero. To me, that still very much recommends getting vaccinated.”

“There isn’t any doubt that influenza vaccine is a pretty good vaccine, but it’s not an excellent vaccine, like polio or measles,” says William Schaffner, a professor at Vanderbilt University School of Medicine. “Even in the best of times, it’s not capable of completely eliminating infections.”

By comparison, just two measles vaccines prevent about 95 percent of infections, and polio vaccines have eliminated polio in most countries.

The bottom line, is that most years, it will prevent illness, it will prevent hospitalizations, and it will prevent deaths.” But, he added, “it won’t prevent them all and it cannot eradicate influenza,” as vaccines have done for certain other diseases such as polio and measles.

The American examination could help public health planners determine how to get the most our of the vaccine while better vaccines are developed, said Dr. Scott Halperin, director of the Canadian Centre for Vaccinology in Halifax. “A lot of research is going on in the flu vaccine field to get a better vaccine,” Halperin said. “But having said that, you know 59 or 60 percent is still far better than zero percent.”

Andrew Pavia, M.D., who chairs the Pandemic Influenza Task Force of the Infectious Diseases Society of America, said the study confirms what is already understood about the current flu vaccine. “Everyone agrees that we need better vaccines and we are making progress in that direction. We have known for years that the vaccine we have does not provide a first-rate level of protection in the elderly and the very young, but it does provide protection. It would be terrible if the message to the public was that getting vaccinated isn’t important.” In fact, the less effective a vaccine is, the more important it is that as many people as possible are vaccinated so that those who are most vulnerable are protected. “With a vaccine that is less than perfect, which is most of our vaccines, much of the protection comes from having widespread coverage within a community,” Pavia concluded.

Now that the H1N1 swine flu pandemic has officially come to an end, the federal government is planning to change the way it works with companies to counteract new disease threats. Proposed actions include reforming the Food and Drug Administration (FDA) and creating centers that will make vaccines available more quickly than was possible previously. According to a Department of Health and Human Services (HHS) report, the nation’s ability to respond to pandemics is too slow and that changes must be made. The report also contains a plan to help researchers and biotech firms bring new drugs and vaccines to the market in record time.

“At a moment when the greatest danger we face may be a virus we have never seen before…we don’t have the flexibility to adapt,” said HHS Secretary Kathleen Sebelius. The report promotes clearer guidance to industry regarding the kinds of tests need to achieve regulatory approval of new drugs and vaccines, something the pharmaceutical industry has requested. The FDA plans to establish teams to expedite this process. Additionally, HHS and the Department of Defense plan to establish the Centers for Innovation in Advanced Development and Manufacturing, according to the report.

“These centers will provide assistance to industry and government by advancing state-of-the-art, disposable, modular manufacturing process technologies,” the report says. “Finally, in public health emergencies, these centers may augment existing United States manufacturing surge capacity against emerging infectious diseases or unknown threats, including pandemic influenza.”

Dr. Harold Varmus, who wrote a separate report from the Presidential Council of Advisors on Science and Technology, said “Accelerated delivery of vaccines by even a few weeks can mean saving tens of thousands of lives. Sebelius noted that the government has not invested adequately in “regulatory science” – studying the optimal means to test new products. “Because of this under-investment, we are often testing and producing cutting-edge products using science that is decades old. We are also going to reach out to product developers earlier in the process so they know what to expect,” Sebelius said.

The H1N1 flu pandemic is officially at an end, according to the World Health Organization (WHO). The announcement came months after many nations canceled vaccine orders and shut down telephone hotlines as the illness disappeared from the headlines. Margaret Chan, the WHO’s director, said that the pandemic had “largely run its course” and that the phase six alert – the highest influenza level – is officially at an end. “I fully agree with the committee’s advice,” Chan said. At present, the virus is in the “post-pandemic” phase, meaning disease activity has returned to levels normally seen for seasonal flu bugs.

Chan cautioned against complacency, noting that “It is likely that the virus will continue to cause serious disease in younger age groups”, she said and urged high-risk individuals such as pregnant women to be vaccinated against the disease. A total of 18,449 people have died across the globe since the H1N1 flu first appeared in April of 2009. Chan defended her decision to declare swine flu a pandemic, saying it was based on the globally agreed rules that were in place at the time. “We have been aided by pure good luck,” she said, noting that if the virus had mutated, the death rate would have soared. Angus Nicoll, flu program coordinator with the European Center for Disease Prevention and Control, said the declaration that the pandemic had ended was consistent with the Stockholm-based organization’s views.

An interesting point is that while reports of flu in the northern hemisphere are at seasonal lows, nations in the southern hemisphere (where it is currently winter) show few people are seriously ill with swine flu, Nicoll said. Still, healthcare workers should get ready for a new seasonal flu that will combine elements of the pandemic H1N1 strain, the older H3N2 strain and additional lesser strains, according to Nicoll, who said “It looks sort of middle of the road at the moment.”

“Lurking in the background we still have H5N1,” Chan said in a reference to the bird flu that has sickened 503 people over seven years and killed 299 of them. Chan’s advice for the future is for people to get their usual seasonal flu shot this fall to protect against the disease.

“We are making this decision only in the interest of the Polish patient and the taxpayer,” Tusk said. “We will not take part because it’s not honest and it’s not safe for the patient.” The anti-vaccine movement claims that the H1N1 inoculation is untested or contains unsafe ingredients, such as the preservative thimerosal. The World Health Organization disagrees and points out that more than 150 million people in 40 nations have been vaccinated and suffered no abnormal or dangerous reactions.

The lone Polish official to protest is Janusz Kochanowski, the ombudsman for civil rights, who calls the unavailability of the vaccine an unnecessary risk to the country’s health. Ironically, Kochanowski himself came down with H1N1 flu over Christmas. Poland’s response to the vaccine stands in sharp contrast to the United States, where President Barack Obama and his family were inoculated against H1N1 flu to set an example.

“The saving grace for Poland is that this swine flu pandemic is so far very mild. It would be a big scandal if this were a virus that would cause many deaths,” said Andrew McMichael, an immunologist and director of the Weatherall Institute of Molecular Medicine at Oxford.

“It’s probably going to be the mildest pandemic on record – compared to the three that happened in the 20th century,” according to Marc Lipsitch, a professor of epidemiology at the Harvard School of Public Health and co-author of an article in the journal Public Library of Science.

If 15 percent of the population is stricken with H1N1, hospitalizations could range from approximately 70,000 to 600,000. Lipsitch expects hospitalizations will fall in the middle of that range, which is what happens in a typical flu season. The H1N1 death rate has been less than during a normal flu season. The difference is that most of the deaths have been children, teenagers and adults under the age of 50. In a typical year, flu tends to kill people over age 65. The reason is that younger people are getting H1N1 flu, while older people are not.

This alert might strike some people as alarmist, given that “regular” flu kills 36,000 Americans every year – compared with the single death so far we’ve seen in the United States and the 13 confirmed deaths worldwide so far in the current outbreak. But looking at it more closely, the WHO’s preemptive strike may be motivated more by historical fact than today’s news. The Spanish Influenza of 1918 – 1920, which arrived in a similar time frame, infected 28 percent of all Americans; an estimated 675,000 Americans died of the disease and about 50 million across the globe. Clearly, this was a different order of pandemic at a time when the global health system was recovering from WWI and ill-equipped to deal with the emergency. But where it bears some resemblance to swine flu is that the first wave of flu appeared early in the spring of 1918. It disappeared over the summer, with the second wave arriving in Boston in September of 1918. With the number of cases expected to grow into the thousands, according to the chief at Mexico City’s National Institute of Respiratory Diseases’ Center for the Investigation of Infectious Diseases in Mexico City, the WHO’s response is understandable and responsible.

The one concern is on behalf of our already burdened health system. Raising the alert level puts pressure on our emergency rooms especially as people are likely to interpret any flu-like symptoms as signs of H1N1 flu. This is when communication with the public is critical. Representatives of the CDC should be using the copious air time they’re being given not only to report on the level of the contagion but to educate the public about its symptoms and to calm fears.

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